Winds and Percussion Form

  • Winds and Percussion Camp Form

    Registration and Medical Information
    Please complete the registration no later than May 22. If completed by May 22, the fee is refundable less a $50 administrative fee. For more information, contact James Swearingen at or Megan Hennes at Information and maps will be sent the week of May 22, 2017.  
    First Name
    Last Name

    Middle Initial


    Home Phone

    Emergency Phone #1

    Emergency Phone #2
    Parent's Email (for camp reminders, updates and materials)

    Grade (Fall of 2017)

    Instrument (for baritones, please indicate bass or treble clef)
    Current Director's Name 
    Current Director's preferred Email Address*
    School (current)

    School Address



    Zip Code

    Shirt Size (adult sizes)

    Years of participation

    Important Medical Information

    Name(s) of Parent(s) / Guardian(s)

    Name of Physician
    Physician Phone

    Date of Last Tetanus Shot 

    If participant has a physical or other condition that may pose an undue risk to the participant or others in the program, please provide necessary information or special requirements (e.g., medications) or requested accommodations. 
     I hearby give permission for emergency medical treatment of the child named above by his/her own physician or a physician on-call. 

     I authorize my child to participate in all activities of the Capital University Winds and Percussion Camp, June 5-9, 2017. I understand he/she is expected to observe all camp rule and in case of failure to do so, I am responsible for immediate transportation home. I further understand and agree  that there will be no refund of camp fees in the event of my child's dismissal from any portion of the camp.

    By submitting this form, you agree that all information contained within is correct and that you are the legal guardian of the participant as stated in this form.

    Please do not attempt to submit more than once. The form may take several seconds to process.